Baker, Edna y
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edna M.Baker Female
r , Date of Death Age If Veteran of U.S.Armed Forces,
„l` 06/06/2018 65 Years War or Dates
Place of Death Hospital, Institution or
'; City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death ffie Natural Cause p Accident ❑Homicide 0 Suicide 0 Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
" Andrew Marthy
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
'` City, Town or Village 0101 1240
�x ty 9 Albany
„- ❑Burial Date Cemetery or Crematory
06/07/2018 Pineview Crematorium
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal
and/or Held
and/or Address
Hold
„k Date Point of
0 Transportation Shipment
-' by Common Destination
a1 Carrier
Q Disinterment
Date Cemetery Address
Y Date CemeteryAddress
Q Reinterment
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Y Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
i
Permission is hereby granted to dispose of the human remains described above as indicated.
X Date Issued 06/07/2018 Registrar of Vital Statistics Danielle S Gillespie(El ctronicalry Signed)
(signature)
District Number Place
0101 Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition t.1'1(1 f Place of Disposition eic-- Ciltz-
(address)
rf,`- (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 4all.
1L
` (please pri
Signature Title ('► IC", /LIE-
(over)
DOH-1555 (02/2004)